Colorectal cancer screening is underused, and primary care clinicians are challenged to provide patient education within the constraints of busy practices.
Dr Jane Zapka and colleagues from Massachusetts in America carried out a randomized, controlled trial in 5 primary care practices in Massachusetts.
The research group aimed to test the effect of an educational video, mailed to patients' homes before a physical examination, on performance of colorectal cancer screening, particularly sigmoidoscopy.
The researchers included 938 patients age 50 to 74 years who were scheduled for an upcoming physical examination, had no personal history of colorectal cancer, and were eligible for lower-endoscopy screening according to current guidelines.
The researchers randomly assigned participants to receive usual care (n = 488) or a video about colorectal cancer, the importance of early detection, and screening options (n = 450).
The investigators conducted baseline and 6-month follow-up telephone assessments.
A dependent variable classified screening since baseline as 1) sigmoidoscopy with or without other tests, 2) another test or test combination, or 3) no tests.
The overall screening rates were found to be 55% in both the intervention and the control groups.
|Intervention dose (viewing at least half of the video) was related to receiving sigmoidoscopy|
|Annals of Internal Medicine|
In regression modeling, the researchers noted that intervention participants were nonsignificantly more likely to complete sigmoidoscopy alone or in combination with another test.
In addition, the research team found that intervention dose (viewing at least half of the video) was significantly related to receiving sigmoidoscopy with or without another test.
Recruitment records showed that at least 23% of people coming for periodic health assessments were currently screened by a lower-endoscopy procedure and therefore were not eligible.
The primary care sample studied consisted primarily of middle-class white persons who had high screening rates at baseline and so the results may not be generalizable to other populations.
Dr Zapka commented, "The trial was conducted during a period of increased health insurance coverage for lower-endoscopy procedures and public media attention to colon cancer screening."
Hence she concluded that "A mailed video had no effect on the overall rate of colorectal cancer screening and only modestly improved sigmoidoscopy screening rates among patients in primary care practices."